Pulmonary oedema nitrate — DipIMC MCQ

Correct answer: B — Glyceryl trinitrate according to local protocol

Explanation lettering: B = shown as A · C = shown as B · D = shown as C · A = shown as D

C is correct: Hypertensive pulmonary oedema may respond to nitrates where blood pressure and contraindications allow. A is less suitable because analgesia is important but does not replace the first physiological intervention; B is less suitable because the dose is below standard severe adult asthma nebuliser dosing; D is less suitable because this is not a definitive treatment for the condition described; E is less suitable because it is a common auto-injector dose rather than the adult healthcare dose. The most tempting alternative is therefore suboptimal because it either delays the time-critical pre-hospital intervention or sends the patient to the wrong level of care. The key DipIMC principle is focused cABCDE decision-making with early pre-alert, triage or retrieval escalation when the scene physiology demands it.

Reference: JRCALC Guidelines; Resuscitation Council UK; NICE guidance where applicable